{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:07:22Z","timestamp":1785409642534,"version":"3.56.0"},"reference-count":34,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) Programme","award":["2027236"],"award-info":[{"award-number":["2027236"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome represents the complex interplay between cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic disorders such as type 2 diabetes and obesity. These conditions share overlapping risk factors, pathophysiological mechanisms, and clinical outcomes, leading to progressive organ dysfunction, as well as increased morbidity and mortality. Traditional disease-specific care models, in which cardiology, nephrology, and endocrinology operate in separate clinics, are increasingly inadequate for addressing the integrated nature of CKM syndrome. Patients often experience fragmented care, with different specialties prioritizing different medications and communicating slowly via letters, which delays important guideline-directed medical therapy (GDMT) for each organ system, potentially leading to higher rates of hospital admissions and mortality. New models of care are urgently needed to improve outcomes through coordinated, patient-centered, and multidisciplinary approaches. Future integrated CKM care models should emphasize cross-specialty collaboration, data sharing, and shared decision-making to optimize treatment and deliver comprehensive care plans that consider all three specialty domains. Advances in digital health, precision medicine, and population health analytics can support these models by enabling more accurate risk stratification, personalized interventions, and continuous monitoring across the care continuum. This review, originating from an International Society of Nephrology Transplant Sister Center Meeting, synthesizes the available evidence on multispecialty clinics and other interventions designed to improve care for patients with multiple CKM comorbidities.<\/jats:p>","DOI":"10.31083\/rcm47862","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:43Z","timestamp":1785407503000},"source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular\u2013Kidney\u2013Metabolic Syndrome: Models of Care"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1517-4359","authenticated-orcid":true,"given":"Isaac","family":"Chung","sequence":"first","affiliation":[{"name":"Renal and Transplantation Unit, St George\u2019s University Hospitals NHS Foundation Trust, SW17 0QT London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorottya I.","family":"Fricska","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Health and Medical Sciences, City St George\u2019s, University of London, SW17 0RE London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suvro","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Apollo Multispecialty Hospitals, 700054 Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Apollo Multispecialty Hospitals, 700054 Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Hugo Gomez","family":"Johnson","sequence":"additional","affiliation":[{"name":"Nephrology Department, Instituto Nacional de Cardiologia, Ignacio Chavez, 14080 Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas M.P.","family":"Annear","sequence":"additional","affiliation":[{"name":"Renal and Transplantation Unit, St George\u2019s University Hospitals NHS Foundation Trust, SW17 0QT London, UK"},{"name":"Department of Medicine, School of Health and Medical Sciences, City St George\u2019s, University of London, SW17 0RE London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpita Ray","family":"Chaudhury","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Post Graduate Medical Education & Research (IPGMER), 700020 Kolkata, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mimi","family":"Chen","sequence":"additional","affiliation":[{"name":"Renal and Transplantation Unit, St George\u2019s University Hospitals NHS Foundation Trust, SW17 0QT London, UK"},{"name":"Department of Medicine, School of Health and Medical Sciences, City St George\u2019s, University of London, SW17 0RE London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Anderson","sequence":"additional","affiliation":[{"name":"Renal and Transplantation Unit, St George\u2019s University Hospitals NHS Foundation Trust, SW17 0QT London, UK"},{"name":"Department of Medicine, School of Health and Medical Sciences, City St George\u2019s, University of London, SW17 0RE London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-2325","authenticated-orcid":true,"given":"Debasish","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Renal and Transplantation Unit, St George\u2019s University Hospitals NHS Foundation Trust, SW17 0QT London, UK"},{"name":"Department of Medicine, School of Health and Medical Sciences, City St George\u2019s, University of London, SW17 0RE London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Sebastian SA, Padda I, Johal G. Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review. Current Problems in Cardiology. 2024; 49: 102344.","DOI":"10.1016\/j.cpcardiol.2023.102344"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Narula J, Butler J, Chothia Y, Bannerjee D, Jarraya F, Ulasi I, et al. Optimising Access to Care for Patients with Heart and Kidney Diseases: A World Heart Federation and International Society of Nephrology White Paper. Global Heart. 2025; 20: 88.","DOI":"10.5334\/gh.1460"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, et al. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023; 148: 1606\u20131635.","DOI":"10.1161\/CIR.0000000000001184"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Weber C, Beaulieu M, Djurdjev O, Er L, Taylor P, Ignaszewski A, et al. Towards rational approaches of health care utilization in complex patients: an exploratory randomized trial comparing a novel combined clinic to multiple specialty clinics in patients with renal disease-cardiovascular disease-diabetes. Nephrology, Dialysis, Transplantation. 2012; 27: iii104\u2013iii110.","DOI":"10.1093\/ndt\/gfr292"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Essa H, Walker L, Mohee K, Oguguo C, Douglas H, Kahn M, et al. Multispecialty multidisciplinary input into comorbidities along with treatment optimisation in heart failure reduces hospitalisation and clinic attendance. Open Heart. 2022; 9: e001979.","DOI":"10.1136\/openhrt-2022-001979"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Dubrofsky L, Lee JF, Hajimirzarahimshirazi P, Liu H, Weisman A, Lawler PR, et al. A Unique Multi- and Interdisciplinary Cardiology-Renal-Endocrine Clinic: A Description and Assessment of Outcomes. Canadian Journal of Kidney Health and Disease. 2022; 9: 20543581221081207.","DOI":"10.1177\/20543581221081207"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Al-Chalabi S, Alderson H, Garratt N, Green D, Kalra PA, Ritchie J, et al. Improving outpatient clinic experience: the future of chronic kidney disease care and associated multimorbidity. BMJ Open Quality. 2023; 12: e002188.","DOI":"10.1136\/bmjoq-2022-002188"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Ev\u00e9n G, Stenfors T, Jacobson SH, Jernberg T, Franz\u00e9n-Dahlin \u00c5, J\u00e4ghult S, et al. Integrated, person-centred care for patients with complex cardiovascular disease, diabetes mellitus and chronic kidney disease: a randomized trial. Clinical Kidney Journal. 2024; 17: sfae331.","DOI":"10.1093\/ckj\/sfae331"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Marques P, Mavrakanas TA, Guida J, G\u00e9d\u00e9on T, Emami A, Alaamiri A, et al. Utilizing synchronous care to improve cardiovascular and renal health among patients with type 2 diabetes: Proof-of-concept results from the DECIDE-CV clinical programme. Diabetes, Obesity & Metabolism. 2024; 26: 3448\u20133457.","DOI":"10.1111\/dom.15691"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Ramos T, Verma A, Speirits I, Zhang L, McInally J, McShane C, et al. Evaluating a pharmacist-led cardio-renal-metabolic service to reduce healthcare inequities in a socioeconomically deprived population: a prospective intervention study. International Journal of Clinical Pharmacy. 2025; 47: 1395\u20131405.","DOI":"10.1007\/s11096-025-01938-8"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Neeland IJ, Arafah A, Bourges-Sevenier B, Dazard JE, Albar Z, Landskroner Z, et al. Second-year results from CINEMA: A novel, patient-centered, team-based intervention for patients with Type 2 diabetes or prediabetes at high cardiovascular risk. American Journal of Preventive Cardiology. 2023; 17: 100630.","DOI":"10.1016\/j.ajpc.2023.100630"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Pagidipati NJ, Nelson AJ, Kaltenbach LA, Leyva M, McGuire DK, Pop-Busui R, et al. Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes: A Randomized Clinical Trial. JAMA. 2023; 329: 1261\u20131270.","DOI":"10.1001\/jama.2023.2854"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, B\u00f6hm M, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. The New England Journal of Medicine. 2021; 385: 1451\u20131461.","DOI":"10.1056\/NEJMoa2107038"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Kosiborod MN, Abildstr\u00f8m SZ, Borlaug BA, Butler J, Rasmussen S, Davies M, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. The New England Journal of Medicine. 2023; 389: 1069\u20131084.","DOI":"10.1056\/NEJMoa2306963"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Solomon SD, McMurray JJV, Vaduganathan M, Claggett B, Jhund PS, Desai AS, et al. Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. The New England Journal of Medicine. 2024; 391: 1475\u20131485.","DOI":"10.1056\/NEJMoa2407107"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Rangaswami J, Tuttle K, Vaduganathan M. Cardio-Renal-Metabolic Care Models: Toward Achieving Effective Interdisciplinary Care. Circulation. Cardiovascular Quality and Outcomes. 2020; 13: e007264.","DOI":"10.1161\/CIRCOUTCOMES.120.007264"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Alqahtani M, Ganni E, Mavrakanas T, Tsoukas M, Peters T, Suri R, et al. Synchronous Health Care Delivery for the Optimization of Cardiovascular and Renal Care in Patients with Type 2 Diabetes. Current Cardiology Reports. 2022; 24: 979\u2013985.","DOI":"10.1007\/s11886-022-01715-3"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Nguyen M, Rumjaun S, Lowe-Jones R, Ster IC, Rosano G, Anderson L, et al. Management and outcomes of heart failure patients with CKD: experience from an inter-disciplinary clinic. ESC Heart Failure. 2020; 7: 3225\u20133230.","DOI":"10.1002\/ehf2.12796"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Parmar S, Lopez T, Shah R, Murphy D, Warrens H, Khairallah M, et al. Risk of Hospital Admissions and Death in Patients with Heart Failure and Chronic Kidney Disease: Findings from a Novel Multidisciplinary Clinic. Cardiorenal Medicine. 2025; 15: 249\u2013260.","DOI":"10.1159\/000541806"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Mark PB, Stafford LK, Grams ME, Aalruz H, Abd ElHafeez S, Abdelgalil AA, et al. Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. 2025; 406: 2461\u20132482.","DOI":"10.1016\/S0140-6736(25)01853-7"},{"key":"ref21","unstructured":"International Diabetes Federation. IDF Diabetes Atlas 2025. Available at: https:\/\/diabetesatlas.org\/resources\/idf-diabetes-atlas-2025\/ (Accessed: 5 January 2026)."},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Noubiap JJ, Nansseu JR, Nyaga UF, Ndoadoumgue AL, Ngouo AT, Tounouga DN, et al. Worldwide trends in metabolic syndrome from 2000 to 2023: a systematic review and modelling analysis. Nature Communications. 2025; 17: 573.","DOI":"10.1038\/s41467-025-67268-5"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. Journal of the American College of Cardiology. 2025; 86: 2167\u20132243.","DOI":"10.1016\/j.jacc.2025.08.015"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Patel A, Praveen D, Maharani A, Oceandy D, Pilard Q, Kohli MPS, et al. Association of Multifaceted Mobile Technology-Enabled Primary Care Intervention With Cardiovascular Disease Risk Management in Rural Indonesia. JAMA Cardiology. 2019; 4: 978\u2013986.","DOI":"10.1001\/jamacardio.2019.2974"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Martens T, Beck RW, Bailey R, Ruedy KJ, Calhoun P, Peters AL, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial. JAMA. 2021; 325: 2262\u20132272.","DOI":"10.1001\/jama.2021.7444"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Golbus JR, Gosch K, Birmingham MC, Butler J, Lingvay I, Lanfear DE, et al. Association Between Wearable Device Measured Activity and Patient-Reported Outcomes for Heart Failure. JACC. Heart Failure. 2023; 11: 1521\u20131530.","DOI":"10.1016\/j.jchf.2023.05.033"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Boehmer JP, Cremer S, Abo-Auda WS, Stokes DR, Hadi A, McCann PJ, et al. Impact of a Novel Wearable Sensor on Heart Failure Rehospitalization: An Open-Label Concurrent-Control Clinical Trial. JACC. Heart Failure. 2024; 12: 2011\u20132022.","DOI":"10.1016\/j.jchf.2024.07.022"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Gama RM, Nebres D, Bramham K. Community Point of Care Testing in Diagnosing and Managing Chronic Kidney Disease. Diagnostics. 2024; 14: 1542.","DOI":"10.3390\/diagnostics14141542"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Komenda P, Lavallee B, Ferguson TW, Tangri N, Chartrand C, McLeod L, et al. The Prevalence of CKD in Rural Canadian Indigenous Peoples: Results From the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) Screen, Triage, and Treat Program. American Journal of Kidney Diseases. 2016; 68: 582\u2013590.","DOI":"10.1053\/j.ajkd.2016.04.014"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Escrib\u00e1-Mart\u00ed G, C\u00e1mara-Ramos I, Climent-Catal\u00e1 MT, Escudero-Quesada V, Salar-Ib\u00e1\u00f1ez L. Pharmaceutical care program for patients with chronic kidney disease in the community pharmacy: Detection of nephrotoxic drugs and dose adjustment. Viability study. PLoS ONE. 2022; 17: e0278648.","DOI":"10.1371\/journal.pone.0278648"},{"key":"ref31","unstructured":"NHS England. Managing heart failure @home. 2025. Available at: https:\/\/www.england.nhs.uk\/nhs-at-home\/managing-heart-failure-at-home\/ (Accessed: 9 October 2025)."},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Vijayaraghavan K, McCullough PA, Singh B, Gupta M, Enas E, Mohan V, et al. Cardiometabolic-Renal Disease in South Asians: Consensus Recommendations from the Cardio Renal Society of America. Cardiorenal Medicine. 2019; 9: 240\u2013251.","DOI":"10.1159\/000499341"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Huang Q, Li Y, Zhou X, Zou X, Ji L. Prevalence of the Cardiovascular-Kidney-Metabolic Syndrome in 3 Chinese Cohorts. JACC. Asia. 2025; 5: 116\u2013118.","DOI":"10.1016\/j.jacasi.2024.10.016"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Khan SS, Matsushita K, Sang Y, Ballew SH, Grams ME, Surapaneni A, et al. Development and Validation of the American Heart Association\u2019s PREVENT Equations. Circulation. 2024; 149: 430\u2013449.","DOI":"10.1161\/CIRCULATIONAHA.123.067626"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM47862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:32:41Z","timestamp":1785407561000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/7\/10.31083\/RCM47862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1530-6550(26)02302-1"],"URL":"https:\/\/doi.org\/10.31083\/rcm47862","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"article-number":"47862"}}